Training pharmacy students about 'drugs of abuse'

WORCESTER — Training in the risks of opiod abuse was embedded in the curriculum of MCPHS University well before state officials started warning of an opiod addiction epidemic earlier this year.

The rapidly growing school, which has a busy campus in Worcester, has had a "Drugs of Abuse" course for at least a decade, and the required pharmacotherapeutics course has traditionally included a two-week substance abuse module.

Assistant professor Evan Horton, who has been teaching both at the school for about five years, said the pharmacy profession has long been aware of the substantial hazards — as well as the widely recognized benefits — of popular opiod-based drugs such as hydrocodone and oxycodone, known by the brand names Vicodin and Percocet.

In recent years, pharmacists have been on the front lines of the opioid crisis as armed robbers have stolen from drugstores for their stocks of opioid painkillers.

A rash of OxyContin robberies plagued drugstores a few years ago, forcing pharmacies to limit supplies; at the same time drugmakers started to make the potent painkiller un-crushable, and therefore un-snortable and uninjectable. It is unclear whether those measures have made pharmacists appreciably safer, people at MCPHS say.

"A lot of pharmacy students have never been around drug addicts or alcoholics, and now they're the ones who are the keepers and will have a gun shoved in their faces," said Mr. Horton, 33. "They're standing in front of a candy store."

However, it is also as important to teach budding pharmacists about the need for compassion for those in pain as it is to be alert to the potential for abuse and to diligently check the prescription history of customers, the professor said.

"You need to understand that just because you're someone who requires a lot of opioids doesn't make you an addict," Mr. Horton said.

And the real addicts who are robbing drugstores?

"You have to understand they're in withdrawal, they're desperate and they're broke," he said.

Horton counsels pharmacy students to not keep guns on the premises, comply with robbers' demands and call the police only when the perpetrators have left and the door is locked.

Students at MCPHS are also grounded in the chemical properties of the opioids they'll be dispensing for a living.

Assistant professor Matthew D. Metcalf holds doctorates in both chemistry and pharmacy and teaches medicinal chemistry at MCPHS and is also researching ways to produce a non-addicting narcotic painkiller.

Mr. Metcalf, an opioid specialist, is adept at the graphical language of chemistry. During a recent interview, he drew on a white board intricate diagrams of the chemical structure of four or five opioid drugs as well as opiates, such as heroin and morphine, and manipulated wire models into three dimensional representations of the drugs.

"People will abuse anything. It's hard-wired into all of nature," Mr. Metcalf said. "And opioids are the gold standard for moderate to severe pain for the foreseeable future."

As for when safe, non-addictive drugs with the same analgesic properties will be developed and widely used, "You're asking me to predict when the Holy Grail will be found," he said.

As a pharmacy professional, Mr. Metcalf said he welcomed Gov. Deval L. Patrick's declaration of a public health emergency amid a spate of opioid overdoses and a widespread perception of an opioid crisis.

However, he said he believes Mr. Patrick's attempted ban of the new hydrocodone painkiller Zohydro — since overturned by a federal judge — was overreaching because there is legitimate value to the drug, which does not contain acetaminophen, known to be toxic to the liver in high doses.

"He was someone trying to act on a crisis but didn't have the full comprehension of the medical compound," Mr. Metcalf said.

"Opioids are getting easier to get and heroin is getting very, very cheap, and that's what's popped in this crisis.

"I think the governor's efforts are those of someone who has realized there's a very, very big crisis and is doing whatever he can," he added. "I applaud that. I don't want my kids to be drug addicts."

Contact Shaun Sutner at ssutner@telegram.com. Follow him on Twitter @ssutner.